Occupational risk factors for depression and anxiety symptoms: Insights from a large cohort study during and after the SARS-CoV-2 pandemic
Swaantje Casjens, Jan Hovanec, Nadine Glaser, Janka Massag, Laura Pfrommer, Nils Opel, André Karch, Saskia Muellmann, Irene Moor, Michael Gekle, Matthias Girndt, Simone Hettmer, Jessica I. Höll, Michael Heuser, Thomas Frese, Rafael Mikolajczyk, Thomas Behrens
Abstract
Objectives
An increased risk for an occupation-related SARS-CoV-2 infection has been linked to higher psychological distress. This online survey investigates the prevalence of depressive and anxiety symptoms in a large sample of 34,303 participants from the German cohort for digital health research (DigiHero) after the pandemic (late 2023, t1) and retrospectively from the Omicron wave (early 2022, t0), emphasizing variations across occupational groups and work-related risk factors.
Introduction
By the end of the pandemic, over 765 million infections and 6.9 million deaths were registered worldwide [1]. Generally, workplaces are considered high-risk environments for transmission, primarily due to proximity and frequent contacts with colleagues, clients, or patients. Early in the pandemic, it became clear that the risk of SARS-CoV-2 infection varied across occupational groups.
Materials and methods
DigiHero study and data assessment
We analyzed data from the ongoing cohort study on digital health research in Germany (DigiHero, DRKS Registration-ID: DRKS00025600). DigiHero was initiated in January 2021 in Halle (Saale) and has since then expanded to a nationwide digital cohort study with currently more than 120,000 participants. Addresses for approximately one-third of households were randomly selected from resident registries across Germany.
Results
Study population
Table 1 depicts the characteristics of the overall study population. Over 60% were employed at the time of the survey, whereas only 1.4% identified themselves as job seekers. Most non-working participants were of retirement age (median 68 years, IQR 64–73 years). A notably higher proportion of women than men participated in the survey (59.6% vs. 39.2%), along with 39 individuals identifying as ’other’. More than 60% of the participants held a university degree.
Discussion
Findings from this study revealed a stable level of psychological distress, with no notable shifts in depressive and anxiety symptoms across two time points during and after the pandemic. However, odds for more severe symptoms varied depending on employment status and type of occupation. Elevated odds were observed in occupations associated with higher SARS-CoV-2 infection exposure, particularly in the healthcare sector during the Omicron wave.
Acknowledgments
We thank all participants in the DigiHero study and the staff of this research initiative. We would also like to acknowledge the excellent data management support provided by Azadeh Rahimighazikalayeh and Christoph Nöllenheidt from the Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bochum, Germany.
Citation: Casjens S, Hovanec J, Glaser N, Massag J, Pfrommer L, Opel N, et al. (2026) Occupational risk factors for depression and anxiety symptoms: Insights from a large cohort study during and after the SARS-CoV-2 pandemic. PLoS One 21(4): e0346871. https://doi.org/10.1371/journal.pone.0346871
Editor: Md Saiful Islam, Johns Hopkins Bloomberg School of Public Health: Johns Hopkins University Bloomberg School of Public Health, UNITED STATES OF AMERICA
Received: September 29, 2025; Accepted: March 25, 2026; Published: April 15, 2026
Copyright: © 2026 Casjens et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data cannot be shared publicly because participants did not give consent for the publication of the raw data. Participants only consented to the publication of the results in aggregated form. Data can be requested via email to DigiHero (digihero-studie@uk-halle.de) and will be reviewed by the DigiHero Use and Access Committee.
Funding: This project was conducted with data (Use and Access Application No. 1) from the German study on digital health research (DigiHero, www.medizin.uni-halle.de/digihero). The management of the DigiHero cohort is funded by the internal means of participating institutions. Recruitment of participants in Saxony-Anhalt was partly supported by the Ministry of Economic Affairs, Science and Digitalisation of Saxony-Anhalt. In the federal state of Thuringia, recruitment was partly funded by the German Center for Mental Health (DZPG), site Halle-Jena-Magdeburg. In Bremen and the surrounding districts, the recruitment was funded by the Leibniz ScienceCampus Digital Public Health. In southern Northern-Westphalia, recruitment was funded by the German Social Accident Insurance (DGUV). In other areas, recruitment was funded by the internal means of the participating institutions and internal funds from the Medical Faculty of the Martin Luther University Halle-Wittenberg. Several publicly funded projects are using DigiHero data and support the generation of new data for subprojects. The funders, the Ministry of Economic Affairs, Science and Digitalisation of Saxony-Anhalt, German Center for Mental Health (DZPG), the Leibniz ScienceCampus Digital Public Health, and the German Social Accident Insurance (DGUV), had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The participating institutions in the respective regions were involved in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The Open Access Publication Fund of the Ruhr University Bochum contributed to publication costs for this manuscript and had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: SC, JH, and TB as staff of the Institute for Prevention and Occupational Medicine (IPA), are employed at the German Social Accident Insurance which supported recruitment in southern Northern-Westphalia. IPA is an independent research institute of the Ruhr University Bochum. The authors are independent from the German Social Accident Insurance in study design, access to the collected data, responsibility for data analysis and interpretation, and the right to publish. The views expressed in this paper are those of the authors and not necessarily those of the sponsor. MH reports research funding to his institution from Abbvie, Bayer Pharma AG, Jazz Pharmaceuticals, Glycostem, PinotBio, Servier, and Toray; honoraria from Astellas, Daiichi-Sankyo, Otsuka, Pfizer, and Servier; and consultancy fees from Abbvie, Ascentage Pharma, Astellas, Daiichi-Sankyo, Janssen, Miltenyi, and Servier. These relationships are unrelated to the work reported in this manuscript and did not influence the research or its interpretation. The other authors declare no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
